TB STIGMA – MEASUREMENT GUIDANCE

TB is the most deadly infectious disease in the world, and stigma continues to play a significant role in worsening the epidemic. Stigma and discrimination not only stop people from seeking care but also make it more difficult for those on treatment to continue, both of which make the disease more difficult to treat in the long-term and mean those infected are more likely to transmit the disease to those around them. TB Stigma – Measurement Guidance is a manual to help generate enough information about stigma issues to design and monitor and evaluate efforts to reduce TB stigma. It can help in planning TB stigma baseline measurements and monitoring trends to capture the outcomes of TB stigma reduction efforts. This manual is designed for health workers, professional or management staff, people who advocate for those with TB, and all who need to understand and respond to TB stigma

'I want support, not comments': children's perspectives on supports in their lives

Supports are a major part of the daily lives of children with special educational needs who participate in general education schools. Little attention has been paid to how they experience supports. Six children and their peers who were interviewed appreciated supports because they remove restrictions in activities due to the impairment. However, the analysis also shows how these positive supports can have negative psycho-emotional repercussions, and that they are less focused on addressing disabling barriers. The children’s accounts demonstrate the ambiguous and situated nature of supports, and need for the children to be able to direct supports as ‘chief partners’ in the inclusion process

Fostering Awareness, Inclusivity, and Self-Efficacy: Facing Social and Internalized Recovery Stigma

A dynamic interplay takes place between social, public, and internalized addiction and recovery stigma. This systematic literature review sought to further understand the pervasive relationship between social stigma and internalized stigma around addiction, as well as clinical implications for alleviating the effects of shame and empowering those in recovery. A total of 14 studies were included in the final sample. The results of this review depict three main themes which explore the nature of social and internalized stigma as well as implications for responding to the effects of internalized stigma: Individual Identity Transformation, Group Belonging and Social Support, and Public Education and Awareness. Each theme identified within this review further delves into the interconnected nature of social and internalized stigma while also identifying pathways for fostering awareness, inclusivity, and self-efficacy. Furthermore, the results of this review indicate the need for an integrative and collaborative approach to understanding and addressing addiction and recovery stigma on a micro, mezzo, and macro level. This research proposes the effects of internalized stigma can be alleviated by raising awareness, building belonging and inclusivity, and fostering self-efficacy

Shooting horizons: a study of youth empowerment and social change in Tanzania and South Africa

This thesis is a social psychological approach to youth empowerment and social change in urban African contexts. Over a period of 22 months, 39 young people from Dar es Salaam and Soweto participated in a community‐based initiative called Shooting Horizons. The aim of the project was to engage young people in a process of critical consciousness and social action to represent themselves and their communities through their own words and images using Photovoice methodology. Six Photovoice workshops, involving a total of 23 young women and 16 young men, took place in multiple sites, two youth centres in Dar es Salaam and one in Soweto. The data was collected through multiple methods, including a series of 37 photo‐stories, 6 focus groups on development and social change, a record of daily discussion groups, and 1 focus group and 10 individual interviews post‐project. Emerging from the narrative positions of the participants, the project affirms the different directions for living envisaged by young people and promotes alternatives to the stigmatization of young people and their communities by the grand discourses and practices of development. Through a social psychological lens, I explore the impact that stigmatizing representations of development have on individual and social identities in order to make sense of the contradictions and ambiguities that it presents for enacting social change. I argue that a community empowerment framework, supported by an agenda of resistance to the exclusionary discourses and practices of development, can overcome some of the complex mechanisms of power that lead to oppressive social stratifications. The analysis observes the politics of knowledge and recognition in constructing social identities and building social capital to open up spaces for alternatives within the limitations of these particular contexts. The findings of this study consistently refer to how ‘difference’ is imbued in the narratives of young people and the need to address the gendered and racialized beliefs that contribute to participants’ internalized and victimising perspectives and that constrain processes of social change. Recommendations include practical, concrete, and innovative methods for urban African youth to engage in initiatives that suit their own development interests within a social psychological approach to empowerment that redefines community as a space of inbetweens, a citizenry of people sharing common interests and different agendas

The Deserving Patient: Blame, Dependency, and Impairment in Discourses of Chronic Pain and Opioid Use

Negative stereotypes about people with chronic pain pose a barrier in the delivery of care; contribute to worsening symptoms of physical and psychological distress; and play a role in policy decisions that adversely affect patients and providers. Pain-care seekers may be accused of malingering, laziness, mental aberration, attention seeking, and drug seeking. The propagation of stigmatizing attitudes was explored in this Critical Discourse Analysis of online-reader-comments responding to a series of pain-care policy articles published by a large metropolitan newspaper. Results suggest that framing pain patients as legitimate and deserving can inadvertently reproduce the inequities advocates seek to redress. Ascriptions of deservingness were associated with the locus of choice and agency. Assignments of blameworthiness were used to distinguish the legitimate pain patient from the illegitimate care seeker. Motivation for seeking pain care, as much as the effects of opioids, provided crucial determinants in evaluating legitimacy claims and blame ascriptions. Evaluations of deservingness were predicated on the valence of social regard. Compassion, empathy, respect and believability were rewards of positive social regard. The subjects of addiction and drug abuse were maligned to the detriment of people with pain and people with opioid addiction alike. The disease-entity model of chronic pain was associated with psychiatric discourses of mental illness through a narratives inaccurate reality perception. Loss of independence, rationality, and respectability were semantically linked to negative stereotypes of pain patients, drug addicts, and mentally ill groups. Medical discourses drawing on empirical materialist traditions assert taken-for-granted population categories (e.g. chronic noncancer pain patient) with little acknowledgment of confounding variables, lack of evidence, or their social impact. For the benefit of people seeking care, there is a critical need for moral, logical, and empirical analyses of predicating factors in education and care giving decision-making. The electronic version of this dissertation is at AURA: Antioch University Repository and Archive, http://aura.antioch.edu/ and OhioLINK ETD Center, https://etd.ohiolink.edu/et

The Deserving Patient: Blame, Dependency, and Impairment in Discourses of Chronic Pain and Opioid Use

Negative stereotypes about people with chronic pain pose a barrier in the delivery of care; contribute to worsening symptoms of physical and psychological distress; and play a role in policy decisions that adversely affect patients and providers. Pain-care seekers may be accused of malingering, laziness, mental aberration, attention seeking, and drug seeking. The propagation of stigmatizing attitudes was explored in this Critical Discourse Analysis of online-reader-comments responding to a series of pain-care policy articles published by a large metropolitan newspaper. Results suggest that framing pain patients as legitimate and deserving can inadvertently reproduce the inequities advocates seek to redress. Ascriptions of deservingness were associated with the locus of choice and agency. Assignments of blameworthiness were used to distinguish the legitimate pain patient from the illegitimate care seeker. Motivation for seeking pain care, as much as the effects of opioids, provided crucial determinants in evaluating legitimacy claims and blame ascriptions. Evaluations of deservingness were predicated on the valence of social regard. Compassion, empathy, respect and believability were rewards of positive social regard. The subjects of addiction and drug abuse were maligned to the detriment of people with pain and people with opioid addiction alike. The disease-entity model of chronic pain was associated with psychiatric discourses of mental illness through a narratives inaccurate reality perception. Loss of independence, rationality, and respectability were semantically linked to negative stereotypes of pain patients, drug addicts, and mentally ill groups. Medical discourses drawing on empirical materialist traditions assert taken-for-granted population categories (e.g. chronic noncancer pain patient) with little acknowledgment of confounding variables, lack of evidence, or their social impact. For the benefit of people seeking care, there is a critical need for moral, logical, and empirical analyses of predicating factors in education and care giving decision-making. The electronic version of this dissertation is at AURA: Antioch University Repository and Archive, http://aura.antioch.edu/ and OhioLINK ETD Center, https://etd.ohiolink.edu/et

Going AWOL: Alternative Responses to PTSD Stigma in the U.S. Military

The psychiatric costs of war have contributed to an ‘epidemic of suicide’ linked to PTSD among United States military service personnel. Current research identifies ‘self-stigma as the barrier to care’ and dominant thinking surrounding interventions focuses on overcoming selfstigma to obtain mental health services. The research and programming is grounded in leading social- cognitive and behavioral models that focus on individual interactions. This descriptive analysis of high-profile AWOL cases provides a counter-narrative to this predominant biomedical discourse. In these cases, soldiers chance increased stigmatization through risking dishonorable discharge in their pursuit of care. The question emerges, is lack of help-seeking taking place due to self-stigmatizing or due to broader structural elements that restrict choices? And more critically, are dominant theories of health behavior that focus on individual choice relevant in contexts where there is limited autonomy? Preliminary ethnographic research with veterans and active duty soldiers in addition to content analysis of online military blogs and investigative news reports explore these questions. Anthropological models are introduced to provide a more fixed consideration of structural influences on individuals’ actions and to offer an alternative approach to intervention

Troubling Vulnerability: Designing with LGBT Young People's Ambivalence Towards Hate Crime Reporting

HCI is increasingly working with ?vulnerable? people yet there is a danger that the label of vulnerability can alienate and stigmatize the people such work aims to support. We report our study investigating the application of interaction design to increase rates of hate crime reporting amongst Lesbian, Gay, Bisexual and Transgender young people. During design-led workshops participants expressed ambivalence towards reporting. While recognizing their exposure to hate crime they simultaneously rejected ascription as victim as implied in the act of reporting. We used visual communication design to depict the young people?s ambivalent identities and contribute insights on how these fail and succeed to account for the intersectional, fluid and emergent nature of LGBT identities through the design research process. We argue that by producing ambiguous designed texts, alongside conventional qualitative data, we ?trouble? our design research narratives as a tactic to disrupt static and reductive understandings of vulnerability within HCI